Healthcare Provider Details

I. General information

NPI: 1801826615
Provider Name (Legal Business Name): OB-GYN CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E IDAHO ST STE 302
BOISE ID
83712-6269
US

IV. Provider business mailing address

100 E IDAHO ST STE 302
BOISE ID
83712-6269
US

V. Phone/Fax

Practice location:
  • Phone: 208-343-7501
  • Fax: 208-336-8248
Mailing address:
  • Phone: 208-343-7501
  • Fax: 208-336-8248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateID

VIII. Authorized Official

Name: DENNIS M SCHNEIDER
Title or Position: ADMINISTRATOR
Credential:
Phone: 208-343-7501